There is a social stigma that transsexualism is simply a lifestyle choice; however, our findings support a biological basis of how gender identity develops.
(Dr. V. Harley, Prince Henry Inst. of Medical Research, Melbourne)

Again researchers claim to have found the cause of male to female transsexualism. As usual it would be a genetic deviation. But even this is presupposing too few androgens makes you female (or gay!). But how realistic is this discovery? Does it really provide the answer to where trans* comes from?

Dr. Vincent Harley of Melbourne’s Prince Henry Institute states that male-to-femaletranssexualism is caused by chromosomal under-masculinisation because of a defective AR gene. He analysed the DNA analysis of 112 transsexuals, and came to the above mentioned conclusion.

Even if Dr. Harley can convince the sceptics, there are a couple of problems with his idea. His statement “There is a biological basis for gender” needs clarification. Does he then say trans* is a form of gender in its own right, and not an “error” that needs to be fixed? Does he mean with “gender” the difference between men and women? But what difference then? We already know that genes and hormones play a role with gendered development.

Would he mean difference in abilities and behaviours then? That would be a trickier statement. Quite some scientists from different branches of science (neuroscientists, psychologists, biologists already have disproved the significance of these differences.

The fundamental differences between men and women, and between male and female bodies are hardly big enough to say that differences are absolute. Slowly we come to recognise there is virtually no absolute difference between men and women, males and females. Recent research shows many many differences between men and women are bigger within the respective groups than between the groups. Further what makes a man, a woman? Are there non-transsexual males with serious lack of testosterone in the womb? Do they all identify as women then? But to most medical, biological or genetic scientists this has not yet trickled down. They still think the holy grail of gender lies in the genes, or in the brain. *Bzzzt*. *Wrong*. There is no Holy Grail. Even the church recognizes more than one grail, so ….

Since Dr. Harley talks not just about trans*, but also about gender, it is perfectly justified to talk about more than trans*, about the suspected base of transgender.

What does science talk about when it talks about sex (if we take that as the next barrier to take in order to analyse what makes men and women, thus also trans* people – in common parlance). Sex thus. But which element of it? Chromosomes? Gonads? Genitals? Hormones? As prof. dr. Annemarie Mol says “science doesn’t know what it is talking about when it talks about sex”.

Of course Dr. Harley isn’t that bold in his scientific findings, and more research must be done to find out the full consequence of the finding. But in his media appearances he is more adamant. And then I am under the impression he doesn’t know the difference between sex and gender.

And with Brain Storm by Rebecca Jordan-Young who debunks a lot of brain sex science, we have enough reason to doubt the quality of thís research.

International Day for Trans Depathologization, interview with Mauro Cabral, co-director of Global Activists for Trans* Equality

The news announces it this way: “For the first time in history, the World Health Organization (WHO) will throw out transsexuality from the chapter on ‘Mental and Behavioral Disorders’”. But (full) depathologization of gender diversity still seems a remote point on the horizon. What is good and what is better? We asked a key activist who helped create the Argentinian Gender Identity Law, a model for global policy. Mauro Cabral is co-director of Global Action for Trans* Equality (GATE), where he coordinates an international initiative to reform the Eleventh Edition of the International Classification of Diseases (ICD).

After two years of deliberation and pressure from depathologization activists, WHO recently removed the current diagnosis of “transsexualism” from the Mental and Behavioural Disorders chapter of its online [beta edition, transl.] version of the ICD-11, replacing it with a new category of “gender incongruence” in a new chapter on Sexual Health. Does this mean that trans people are not pathologized in the proposed classification? What does it mean, to “depathologize”?

For many trans advocates,depathologization is an emancipation struggle. The terminology itself also is contested. For some, it means full access to rights without any diagnostic requirement; for others, depathologization means eliminating diagnosis and medicalized control over individuals’bodies. There are tensions among advocates around the role of medicine in defining diverse trans experiences and around ownership of the body. Does the need for surgery and hormones represent a radical prosthetic incorporationwith medicine as the tool, or does it express conservative forms of technological expropriation of the body in alienating times of biocapital?1

Mauro Cabral summarizes it this way: “From one perspective, depathologization looks in a way like a Moebius band: striving for the maximal personal freedom seems to put the masking of biomedicine as regulatory principle for transition on the line; settling for less personal freedom risks perpetuation of current biomedical dogma, which diagnoses the wish to transition as personal and political pathology.”

There was a consensus in activism that transsexuality should no longer be considered as a mental illness by 2012. Now it is 2014, and this dream is still unmet. Is everything lost?

You are right. The world in which identifying as a gender different from the one assigned at birth is considered pathological did not end. However, in that time both the Diagnostic and Statistical Manual of Mental Illness (DSM) and the ICD went through an intense process of revision and reform.

What does this new version [of DSM] entail?

First, we need to clarify that, categorically, any diagnosis in the manual of mental disorders is by definition a mental disorder. Now they renamed “gender identity disorder” with an older clinical term of “gender dysphoria.” Where the previous diagnosis pathologizes trans people just for who they are, the “new” category can be seen as a step forward, because it puts the clinical focus on the trans specific experience of (the) suffering and stops when this disappears. In all the world materially or symbolically governed by the DSM and its codes, trans people stay trapped in one form or another of mental illness, and we continue to be cataloged as sufferers.

We need to remember that diagnosis in the DSM Manual is still a conditio sine qua non in many countries in the world, to access rights, like legal recognition and physical medical interventions.For example, the “treatment” for diagnosed suffering, that are still seen under this mark, and never as a biotechnologically mediated self expression.2

And in the case of the ICD reform?

The ICD Working Group called together by the World Health Organization agreed to reduce the scope of the diagnosis and proposed to scrap the current mental diagnostic categories that affect trans people, including “gender identity disorder” and “transvestic fetishism,” among others. This is fundamental: they finally recommended to remove any mention of trans issues in the chapter on mental health disorders. They also proposed new categories in a new non-psychiatric chapter on Sexual Health, including “gender incongruence of adolescents and adults,” and “gender incongruence in childhood”.

In what sense is the new category “gender incongruence” better than the previous?

“Gender identity disorder” is such a damaging diagnosis that almost any replacement category would be at least a bit better. In that sense, “gender incongruence” also avoids diagnosing trans people just for who they are, paying attention to the discomfort that the incongruence could cause between the gender identity and how it is embodied. However, obviously, you can only pathologize incongruence by implicitly invoking a cissexist ideal of (bodily, identitary or expressive) congruence. Also, incongruence is taxonomically linked to suffering and congruence is linked to happiness, with medical approval enjoyed by the congruent, but missing for the others. In other words, it is proposed that identifying as a gender different from the one they gave us at birth stops being a disorder (mental or otherwise), but now the possibility of living our gender in a non stereotypical, dissident, incongruent way could be in danger3.

Why then not fight for eliminating any diagnostic mention once and for all?

The answer is both ground for pride and pain: only one country in the world, ours, Argentina, admits access to legal gender recognition and transitional health services without requiring a diagnosis, psychiatric or otherwise. Denmark recently enacted a similar policy, but only for legal recognition. This means that, in the rest of the world,people who need to have their legal registration or their bodily configuration changed will still need a DSM or ICD code to access these modifications (every time that access not only means authorization but also public or private health coverage). None of these considerations, however, justify the introduction of the category, “gender incongruence of childhood.” Resisting this classification is a focus of our efforts.

But why pathologize trans children?

The simplest explanation is that gender diversity in childhood is still culturally unacceptable, but the “rational” arguments are different. One focuses on the anxiety that daddies and mommies of children, who rebel against social expectations around their sex, may have. So children are pathologized as therapy for adults. Another argument emphasizes diagnosis to facilitate expansion, funding and publication of research on gender diverse children. This argument is both perverse and faulty. There are decades of research and publication on homosexuality, which has long been depathologized. A third argument asserts that diagnosis guarantees inclusion [of gender diversity topics] in education, in a world where sex segregation is so naturalized and depoliticized, and where, sadly, a diagnostic framework still is considered more effective than a human rights framework. Last, both the old and the new diagnoses are justified as providing an archive of clinical history.

What would the function of this archive be?

Inasmuch as the first biotechnological transitional intervention is the administration of puberty hormone blockers, there are [experts] who consider a childhood diagnosis necessary for immediate access to treatment. This position universalizes the need for diagnosis, based on a treatment that is only available in a couple of countries, and it naturalizes that need. Unsurprisingly, the “gender incongruence in childhood” diagnosis is defended precisely by those medical teams that provide the treatment. Even worse, this argument installs hormone treatment as common fate, imposing early diagnosis as a way of ensuring later transition. As medical policy experts like Sam Winter and Simon Pickstone-Taylor have stated: it is obvious that those arguments fail at the hour of tending to the two biggest necessities of the children: to grow up in a world that does not impose normative forms of masculinity or femininity on them through submitting them to a diagnosis, and the need for information, support and containment.

If they eliminate the diagnostic criteria that pathologize gender diversity in childhood, what would happen with those trans children that need special health care?

The ICD already contains and will keep, non-pathologizing codes, that permit access to assessment and professional support when needed, without any diagnosis of physical or mental disorder. In those circumstances where treatment is needed for depression or anxiety of the child (oftentimes produced by hostility and rejection around them), the ICD already contains general codes that cover the issues4.

Can intersex also be approached from a depathologization perspective?

Without a doubt, although the processes and the issues are different. Approaching intersex from a depathologization perspective affirms bodily diversity, which should never be seen as a pathology. It also means the careful work of distinguishing in every intersex body those characteristics that need medical attention from those that don’t. Depathologization activism must also articulate the irreversible consequences of pathologization, including the chronic pain, the sterility, the mutilation and the genital insensitivity, post-surgical trauma, fistulas, chronic infections, and metabolic changes caused by surgical removal of the gonads or pharmacological treatments to “normalize” the body. This is the register of how pathologization makes us ill.

What impact do terms of “disorders of Sex Development” have on the fight to depathologize intersex?

Since the mid-1990s, the intersex movement has disputed the jurisdiction of biomedicine over intersexuality. Even the medical terminology evidences bias and cruelty. At the end of the 19th Century, mythological hermaphroditism was redefined as a category for clinical use and accompanied by many pseudo-hermaphroditisms to expand diagnostic range. By the mid-1920s, a more specialized vocabulary emerged with terminology about intersex bodies, although the old terms still remained. The struggle and success of the intersex movement in the 1990s, to depathologize intersexuality and to appropriate, subvert, and transform diagnostic intersex terminology into a political identity was answered in a new pathologizing attack.

In 2006, a new classification was created, that reorganized the spectrum of intersex bodies into a taxonomy of “Disorders of Sex Development.” As intersex researcher Georgiann Davis argued, this label reestablished medical authority over that jurisdiction in dispute: our bodies. A central aspect for the depathologization of intersex todayis resistance to the imposition of this vocabulary and its variations. For the intersex movement, there is an intrinsic relationship between nomenclature and treatment. Mirtha Legrand notes: “As they see you, so they treat you”. Advances in genetic and in fetal monitoring technology has extended the boundaries of medicalization to reach intersex embryos. They are often de-selected in preimplantation diagnostic procedures that promote selective abortion of intersex fetuses and prenatal drug administration to “prevent” the birth of intersex children.

Which are the political consequences of intersex pathologization?

Intersex activism itself is being psychopathologized and dismissed as a political symptom of disordered bodies. Because normalizing medical interventions usually take place in early childhood, intersex genital mutilation in infancy seems to infantilize the movement. In that way they mutilate our our capacity to be seen as adult activists with more than 20 years of experience in a sustained struggle. In spite of this oppression, the strong presence of intersex activism in regional and international human right systems has decisively contributed to the recognition of these medically unnecessary and non-consentual practices as forms of torture. Like medical abuse and forced, coerced or involuntary sterilization, these medical practices are violations of human rights.

What does depathologization mean for someone who like you lives the consequences of trans and intersex pathologization?

For years there was a prayer in the Spanish speaking world that affirmed:

“My body, primary territory of peace”

I would like to able to subscribe to that, one day. Today is not that day. As long as this war continues (or as I live), what remains of this body is my primary battleground.

This interview appeared first in Spanish in the Argentinian newspaper Página 12, on the occasion of the International Day for the Depathologization of Trans Identities, October 18, 2014

1Hence the question on who owns the body: if exterior criteria are to define what may happen with your your body, are you still the owner, or is it more a complex of medical and capital actors with their interests – owning shares in hormone producing companies or because of their research being paid by pharmaceutical companies? [transl.]

2 Like the remark about prosthetic use of medicine, this hints to self determination how one’s body should look and using medicine as a technical solution to get there.
[transl.]

3Not every trans/gender diverse person wants, needs or can live a “happy congruent” life. If there is a right to self determination, this extends to choosing not to submit to practices meant to become more congruent with society. The right extends to dissidence.
[transl.]

4These existing codes may be augmented with Z-codes, to clarify special needs of trans andgender diverse children(for example, when anxiety is caused by transphobic school bullying). [transl.]

To fight for your rights, you first have to know them. Vreerwerk offers an opportunity for this. On December 9, just before Human Rights Day, we will start with an online training in human rights concerning trans* and intersex issues.

In four webinars you will get to know the human rights systems of Europe and the UN and get a first idea how to use them. What constitutes human rights? How can I use them? Are trans* and intersex people protected? Can we complain to Brussels (EU) or to Strasbourg (Council of Europe)? How to find your way in the UN? What protection is there? What are the Yogyakarta Principles and how useful are they? How to implement UN critique on the national level? These and other questions are the topics of a series of webinars (seminars given over the Internet) to give activists and students a first plunge in the deep sea of human rights for trans* and intersex people.

This training is limited to trans* and intersex because there is already quite some info and many active NGOs on gay and lesbian issues, but there are hardly enough trans* or inter* activists who know how to use the UN or other human rights systems.

“Know your rights” is an entry-level training. No detailed knowledge is needed (though it may work to your advantage). In principle the training will be given on Tuesdays in two-hour webinars.

On request we can discuss other systems (African Human and Peoples Rights Commission, InterAmerican Commission on Human Rights, ASEAN) in extra webinars.

The costs are 150 euros (ex 21% VAT) per participant. Subsidized (richer) NGOs are to pay double, to enable less well off individuals to participate.

For registration or more info, you can send an e-mail to vreerwerk-at-xs4all-dot-nl (preventing the spam monsters that found me ;)

Trans people are seriously disadvantaged by not having accessible trans specific health care. As by not being able to access regular health care because of transphobia and discrimination. Vreerwerk keeps writing and talking about trans health and trans* people’s access to health care. Be it general health care or trans specific. With much discrimination – whether out of ignorance or willingly – trans people are disadvantaged.

We can show how to argue your case using human rights always is being forgotten or submitted to extraordinary requirements to be able to access health care, Vreerwerk offers lectures and workshops – live and on te web – in gaining a human rights background to patients’ rights, to getting your collective health rights.

Vreerwerk has experience in analysing the health rights situation for trans* and intersex people and can help people to advocate for their human rights with regard to good health care that does not discriminate. We are experienced in writing alternative health care standards and have been asked more than once to look at existing practices and advise on them.

We can show how to argue your case using human rights. Central questions here are:

On June 10 we will start the next online training “Fighting for trans* and intersex equality through human rights”. In five bi-weekly two hour webinars you will get information on the following themes:

You will learn how to use mostly the UN system and the European human rights system to influence the national government on implementing obligations they accepted by acceding to human rights treaties.

We will work with both material at hand and look forward to opportunities and obstructions for getting our rights realised. We will look at what can be done with existing material for local implementation and at the same time see that human rights are not a universal solution and have some inherent problems also.

The training comes at €150 (incl. VAT) for individual activists. If you come as a (funded) organization, the tariff is double to enable less well-off activists to participate. If this is still problematic, do send an e-mail and we’ll figure out a solution.

For more detailed info or alternatively participating in a live training, see this page. For registration or questions best send an e-mail to vreerwerk@xs4all.nl.

Vreerwerk

A Dutch name for thorough LGBTI advocacy and gender education. More than ten years on the theatre of transgender and human rights with an extra-ordinary personal story, I am the 'tranny' for your cause.